The International Normalized Ratio (INR) is
commonly used to guide therapy after hepate
ctomy. We hypothesized that the use of thrombelastography (TEG) would demonstrate a de
creased in
ciden
ce of hypo
coagulability in this patient population.
c_2">Methods
Seventy-eight patients were prospectively enrolled before undergoing hepatectomy. INR, TEG, and coagulation factors were drawn before incision, postoperatively, and on postoperative days 1, 3, and 5.
c_3">Results
Patients demonstrated an elevated INR at all postoperative time points. However, TEG demonstrated a decreased R value postoperatively, with subsequent normalization. Other TEG measurements were equivalent to preoperative values. All procoagulant factors save factor VIII decreased postoperatively, with a simultaneous decrease in protein C.
c_4">Conclusions
TEG demonstrated a brief hypercoagulable state after major hepatectomy, with coagulation subsequently normalizing. The INR significantly overestimates hypocoagulability after hepatectomy and these data call into question current practices using the INR to guide therapy in this patient population.
